The ligament of Parks as a key anatomical structure for safer hemorrhoidectomy: Anatomic study and a simple surgical note

Zoulamoglou, Menelaos; Kaklamanos, Ioannis; Zarokosta, Maria; Bonatsos, Vasileios; Piperos, Τheodoros; Theodoropoulos, Panagiotis; Barla, Georgia; Stathopoulou, Ioanna; Mariolis‐Sapsakos, Theodoros

doi:10.1016/j.amsu.2017.10.004

Cited by 7 publications

(5 citation statements)

References 8 publications

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“…The anal cushion is supported by a fibroelastic tissue and smooth muscle. This muscle and the mucosal suspensory ligament or Park's ligament collectively contribute to the formation of Trietz's muscle (Hassan et al, 2016;Zoulamoglou et al, 2017;Lohsiriwat, 2018;Margetis, 2019;Ahmed et al, 2020;Nakashima et al, 2020). The conjoined longitudinal muscle is located inferiorly along the canal, lying between the internal and external anal sphincters (Fig.…”

Section: Anatomy Of the Anal Canalmentioning

confidence: 99%

“…This technique is preferred for gangrenous haemorrhoids, with pedicle ligation after separation of haemorrhoidal tissues from the sphincter (Bhatti et al, 2016;Rakinic, 2018;Gardner et al, 2019). For better outcome, the surgeon should identify Park's liga-ment (Zoulamoglou et al, 2017). Urinary retention, bleeding, fecal or flatus incontinence, perianal wetness, anal stenosis, and recurrence are complications demonstrated when using this technique (Kendirci et al, 2018).…”

Section: Excisions Of Haemorrhoidsmentioning

confidence: 99%

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Worldwide Disease — Haemorrhoids. How Much Do We Know?

Fišere

Groma

Goldiņš

et al. 2021

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Haemorrhoids are highly vascular cushions of connective tissue in the anal canal, which are normal structures of the human body. Haemorrhoidal disease in clinical practice means that there is an abnormal enlargement of the anal cushions when these transform into “anal nodules”, bleed and/or prolapse. Haemorrhoidal disease is very common. Despite numerous studies undertaken and knowledge accumulated on the aetiology and pathogenesis of haemorrhoidal disease in the last decade, the specific mechanisms responsible for the development of the disease are not thoroughly understood. The pathophysiology is most likely multifactorial and complex, manifested by muscle weakness, intrarectal prolapse, changes in vascular pressure and flow in blood vessels, malformations, sphincter damage and failure, venostasis, inflammatory reactions, endothelin and collagen abnormalities, matrix metalloproteinases activity, etc. Currently, treatment guidelines for the haemorrhoidal disease are based on Goligher’s classification. The classification of haemorrhoidal disease should be submitted to revision by including aetiological factors, the dynamism of prolapse, symptomatology, enteropathogenesis, and gender characteristics. The present review is focused on recent data gained by exploring the anatomy, pathophysiology, classification, theories explaining the development of haemorrhoids, as well as aetiological invasive and surgical treatment modalities.

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Section: Anatomy Of the Anal Canalmentioning

confidence: 99%

Section: Excisions Of Haemorrhoidsmentioning

confidence: 99%

Worldwide Disease — Haemorrhoids. How Much Do We Know?

Fišere

Groma

Goldiņš

et al. 2021

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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“…Anal sphincters are a complex structure that is not only constituted of muscle tissue but also includes nerves and connective tissue surrounding the sphincters. Hemorrhoids localized at the anal canal transition zone (ATZ) are in close proximity to the internal anal sphincter and nerve tracts, and this is nicely demonstrated by the visualization of IAS during Ferguson or Milligan-Morgan hemorrhoidectomy procedures [ 10 ] but also by the potential implication of nerve injury in chronic pain after stapled hemorrhoidopexy [ 11 ]. Specific ATZ stem cells participated in rectal mucosa healing at the level of ATZ and beyond [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Isolation and Characterization of Stem Cells from the Anal Canal Transition Zone in Pigs

Balaphas

Meyer²,

Buchs³

et al. 2022

Dig Dis Sci

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Background Utilization of autologous stem cells has been proposed for the treatment of anal incontinence despite a lack of understanding of their mechanism of action and of the physiological healing process of anal sphincters after injury. Aims We aim to develop a technique allowing isolation and further study of local mesenchymal stem cells, directly from anal canal transition zone in pig. Methods Anal canal was resected "en bloc" from two young pigs and further microdissected. The anal canal transition zone was washed and digested with 0.1% type I collagenase for 45 min at 37 °C. The isolated cells were plated on dishes in mesenchymal stem cell medium and trypsinized when confluent. Cells were further used for flow cytometry analysis and differentiation assays. ResultsThe anal canal transition zone localization was confirmed with H&E staining. Following culture, cells exhibited a typical "fibroblast-like" morphology typical of stem cells. Isolated cells were positive for CD90 and CD44 but negative for CD14, CD34, CD45, CD105, CD106, and SLA-DR. Following incubation with specific differentiation medium, isolated cells differentiated into adipocytes, osteoblasts, and chondrocytes, confirming in vitro multipotency. Conclusions Herein, we report for the first time the presence of mesenchymal stem cells in the anal canal transition zone in pigs and the feasibility of their isolation. This preliminary study opens the path to the isolation of human anal canal transition zone mesenchymal stem cells that might be used to study sphincters healing and to treat anal incontinence.

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“…The underlying of the vascular factor is dysfunction of vessel, providing arterial blood flow through the arteries to the cavernous bodies and outflow through the cavernous veins, which leads to dilatation of cavernous bodies and the formation of vascular malformations [1]. If against this background there is a violation of the elastic properties of the rectococcygeal muscle (musculus rectococcygeus, Treitz muscle) and Parks ligament (connective tissue bed of cavernous bodies), which separates the internal hemorrhoid from the external, the internal nodes come out of the anal canal [2,3,4].…”

Section: Introductionmentioning

confidence: 99%

Blood supply of the anal canal in patients with chronic hemorrhoids

Sidoruk

2021

J Educ Health Sport

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The most important factors in the development of chronic haemorrhoids today are considered to be the combination of two factors (vascular and mechanical) that lead to the development of hemorrhoids. The underlying vascular factor is the vascular dysfunction, providing arterial blood flow through the arteries to the cavernous bodies and outflow through the cavernous veins, which leads to dilation of cavernous bodies and the formation of vascular malformations.There were performed clinical examination and treatment of 140 patients with chronic hemorrhoids of stage III-IV according to Goligher. The features of arterial blood supply of the anal canal were evaluated by transrectal ultrasound examination.It was found that there was no clear linear relationship between the number of anal arteries with increased blood flow and the number of hemorrhoidal nodes in the patient. Each node was supplied with blood from one or two arteries: the node placed at 11 o'clock had blood supply from the arteries visualized at 10 and 11 o'clock, the node at 3 o'clock - arteries at 3 and 5 o'clock, the node at 7 o'clock - arteries at 7 and 9 o'clock. The arteries were most frequently visualized at the first (89.4%), the third (93.3%), the seventh (88.8%) and the eleventh (93.4%) hours. With less frequency the hemodynamically significant arteries were visualized at the fifth (65.0%), the ninth (62.8%) and the tenth (66.7%) hours. The arteries that were suppliing blood hemorrhoidal vessels were located in the internal sphincter at a depth of 5 to 10 mm. In the area of 3, 7 and 11 hours, they overlapped with a mosaic pattern that corresponded to the localization of the cavernous body and resembled an arteriovenous fistula according to the СDS.

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The ligament of Parks as a key anatomical structure for safer hemorrhoidectomy: Anatomic study and a simple surgical note

Cited by 7 publications

References 8 publications

Worldwide Disease — Haemorrhoids. How Much Do We Know?

Worldwide Disease — Haemorrhoids. How Much Do We Know?

Isolation and Characterization of Stem Cells from the Anal Canal Transition Zone in Pigs

Blood supply of the anal canal in patients with chronic hemorrhoids

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